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Fixing Incorrect Procedures on an Insurance Claim 

If you create a claim that contains incorrect procedure codes and have not sent it:
1. Delete the Claim.
2. Edit or delete the Procedures.
3. Recreate claim, then Send Claim.

If you create a claim that contains incorrect procedure codes, send it, and claim is denied payment:
1. First make a Commlog entry in the account explaining why payment denied.
2. Open the Claim and change its status to “Waiting to Send.”
3. Delete the claim.
4. Edit or delete the Procedures.
5. Recreate claim, then Send Claim.

If an incorrect procedure is submitted to insurance, insurance pays and check is created, then insurance company demands refund:
1. Open the Claim.
2. Select the procedure(s), then click Supplemental in the Enter Payment area.
3. Enter a negative Insurance Payment (refund), then click OK.
4. If a check needs to be written from the practice to the insurance company, write the check, but leave the entry out of the deposit if using Deposit feature.
or
If the insurance company is subtracting payment from a check for other patients:
   a) Add an Adjustment to the patient's account. The amount should equal the fee charged minus the writeoff (e.g. patient portion).
   b) When that 'bulk' check that includes the negative payment is created, the amount will be correct. Deposit as normal.
   c) Do not change the writeoff (if any) on incorrect procedure(s).
   d) Leave the date as today's date to preserve the record.
   e) The incorrect procedure should stay on record. Select the Procedures, add a note that it was not done, and check the 'HideGraphics' box.

The reason the incorrect procedure needs to stay on record is that paperwork has been submitted to the insurance company and money has exchanged hands.  Just removing it makes it harder to explain in the account and makes your reports incorrect. If you must leave the incorrect procedure because of a claim, just add and predate the correct procedure code after you have followed the steps above. Send the claim again as needed.

If you just need to change a procedure code and there is no claim attached, click Change on the Procedure Info window. 

 

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